Yu Zhongkai, Hu Yubin, Chen Xiuli
Department of Emergency, Liaocheng People's Hospital, Liaocheng, Shandong, China.
Department of Internal Medicine, People's Hospital of Qingyun County, Dezhou, Shandong, China.
Front Cardiovasc Med. 2024 Aug 9;11:1412104. doi: 10.3389/fcvm.2024.1412104. eCollection 2024.
Out-of-hospital cardiac arrest (OHCA) mostly occurs in crowded public places outside hospitals, such as public sports facilities, airports, railway stations, subway stations, and shopping malls. The emergency department of Liaocheng People's Hospital in Shandong Province admitted one patient with OHCA in August 2021, who suddenly suffered a loss of consciousness and cardiac arrest during exercise after dinner. Witnesses immediately gave continuous chest compressions and artificial respiration and called our hospital's emergency department (at 120). Arriving at the emergency department, we continued to provide chest compressions and ventilator-assisted ventilation after performing endotracheal intubation. We administered adrenaline for cardiac excitation, dopamine for maintained blood pressure, sodium bicarbonate to correct the acidosis, and multiple electric defibrillations. However, the patient's cardiac Doppler ultrasound indicated poor cardiac contractions, and extracorporeal membrane oxygenation (ECMO) was started immediately. We performed coronary angiography for the patient with ECMO support, indicating that the patient had an 80% critical stenosis of the left main coronary artery and an 80%-90% stenosis in the middle section of the left anterior descending artery with an aneurysm. Fortunately, there was no obvious stenosis in the right coronary artery. The patient was transferred to the intensive care unit and received comprehensive treatment, including anticoagulation, myocardial nutritional support, improvement of cardiac function, continuous renal replacement therapy, organ function protection, anti-inflammatory treatment, and rehabilitation. Coronary artery bypass grafting was performed after the patient's condition stabilized, and he was finally discharged. ECMO support therapy for patients with cardiac arrest can be considered when economic conditions permit. It is very important to conduct the necessary examinations in the early stage of resuscitation with ECMO support to clarify the cause of the cardiac arrest and to treat it accordingly.
院外心脏骤停（OHCA）大多发生在医院外人员密集的公共场所，如公共体育设施、机场、火车站、地铁站和购物中心。2021年8月，山东省聊城市人民医院急诊科收治了一名院外心脏骤停患者，该患者晚餐后运动时突然意识丧失、心脏骤停。目击者立即进行持续胸外按压和人工呼吸，并拨打我院急诊科电话（120）。到达急诊科后，我们在进行气管插管后继续进行胸外按压和呼吸机辅助通气。我们给予肾上腺素兴奋心脏、多巴胺维持血压、碳酸氢钠纠正酸中毒，并进行多次电除颤。然而，患者的心脏多普勒超声显示心脏收缩功能不佳，立即启动了体外膜肺氧合（ECMO）。我们在ECMO支持下为患者进行了冠状动脉造影，结果显示患者左主干冠状动脉严重狭窄80%，左前降支中段狭窄80%-90%并伴有动脉瘤形成。幸运的是，右冠状动脉无明显狭窄。患者被转入重症监护病房接受综合治疗，包括抗凝、心肌营养支持、改善心功能、持续肾脏替代治疗、器官功能保护、抗炎治疗及康复治疗。患者病情稳定后进行了冠状动脉搭桥手术，最终出院。在经济条件允许的情况下，可考虑对心脏骤停患者进行ECMO支持治疗。在ECMO支持下的复苏早期进行必要检查以明确心脏骤停原因并据此进行治疗非常重要。
